Monday, August 23, 2010

Plus ça change - Ambulatory Clinics Providing Opiate Agonists:

A 1971 paper by Gay and colleagues discuss the US opiate dispensing clinics operating from 1919 to 1923 (there were 44 of them!). they conclude: Today, some 47years later, the time is long overdue to ... reconsider the efficacy of outpatient treatment of addiciton. It seems cler now that (1) institutional programs have failed to establish a broad base of effective treatment, and (2) law enforcement has failed either to stop the flow of drugs or to incarceration all users. We are left with a medical and social problem of staggering dimension." (Int J Addictions 6(2):241-264, June 1971)

And where are we almost 40 years after that assessment? Russia refusing to offer opiate agonist treatment to its estimated 2-3 million addicts; long waiting oists for methadone programs in most of the country where it is legal to provide it; a UK government whose stated aim it is "to stop the widespread prescribing of methadone" and to rely instead on "the use of ‘cold turkey’ residential treatment programmes".